REPORT OF LICENSE SALES
State form 1047 (R24 / 10-03) Approved by the State Board of Accounts 2003
DEPARTMENT OF NATURAL RESOURCES CUSTOMER SERVICE CENTER 402 W WASHINGTON ST. RM W273 INDIANAPOLIS, IN 46204
REPORTING YEAR
2004
INSTRUCTIONS FOR SUBMITTING PAYMENT: Hunting and fishing license agents are required (Indiana Code 14-2-7-6) to submit reports for the sale of licenses. EACH CLERK OR AGENT SHALL REPORT WITHIN 5 DAYS AFTER THE CLOSE OF EACH REPORTING PERIOD TO THE DIVISION OF FISH AND WILDLIFE. If no licenses were sold during the reporting period, write across the face of form "No Sales Made" and indicate the reporting period. Attach void licenses listed in columns 1b to this report for credit. NO CREDIT GIVEN FOR A CARBON COPY. DO NOT COMBINE LICENSE YEARS IN ONE REPORT. DO NOT SEND ONE CHECK IN PAYMENT OF 2 YEARS ACCOUNT. THE REPORTING PERIOD ENDING DATES ARE: February 28, 2004; May 30, 2004; August 29, 2004, November 28, 2004 and February 27, 2005.
CLASS OF LICENSE Resident Hunting Fee $14.25 Remit $13.50 LIST IN SEQUENCE NUMBER OF FIRST AND LAST LICENSE SOLD 1a SERIAL 1b NUMBER NUMBERS OF TOTAL SOLD VOIDED LICENSE VOID CLASS OF LICENSE LIST IN SEQUENCE NUMBER OF FIRST AND LAST LICENSE SOLD 1a SERIAL 1b NUMBER NUMBERS OF TOTAL SOLD VOIDED LICENSE VOID
to to to to to to TOTAL SOLD x REMIT X $13.50 = $
TOTAL VOID x REMIT X $13.50 = $
NonResident Annual Fish Fee $24.75 Remit $24.00
to to to to to to TOTAL SOLD x REMIT X $24.00 = $
TOTAL VOID x REMIT X $24.00 = $
Resident Fishing Fee $14.25 Remit $13.50
to to to to to to to to to to to to to to to to to TOTAL SOLD x REMIT X $13.50 = $
Resident & NonResident 1-Day Fishing Fee $7.00 Remit $6.25
to to to to to to to to to to TOTAL SOLD x REMIT X $6.25 = $
TOTAL VOID x REMIT X $6.25 = $
TOTAL VOID x REMIT X $13.50 = $
NonResident 7-Day Fish Fee $12.75 Remit $12.00
Resident Hunt-Fish Fee $20.75 Remit $20.00
to to to to to to to to to TOTAL SOLD x REMIT X $20.00 = $
TOTAL VOID x REMIT X $20.00 = $
to to to to to to to to to to to to to to to to TOTAL SOLD x REMIT X $12.00 = $ to to to to to to to to to TOTAL SOLD x REMIT X $8.50 = $
Total value of void licenses I am enclosing a check or money order for the total value of sold licenses. Payment in the amount of
TOTAL VOID x REMIT
TOTAL VOID x REMIT X $12.00 = $
Resident Trapping Fee $14.00 Remit $13.25
to to to to to to to to to TOTAL SOLD x REMIT X $13.25 = $
Trout Salmon Stamp Fee $9.25 Remit $8.50
TOTAL VOID x REMIT X $13.25 = $
TOTAL VOID x REMIT X $8.50 = $
Check number (For office use only)
Name of agent (same as on security bond) Trade name Address (number and street or rural route) City and state Account number Signature of preparer ZIP code Email address Date T elephone number
RECEIVED (For office use only)
$ POSTED (For office use only) ( )
CLASS OF LICENSE Resident Deer Fee $24.00 Remit $23.25
LIST IN SEQUENCE NUMBER OF FIRST AND LAST LICENSE SOLD
1a SERIAL NUMBER NUMBERS OF SOLD VOIDED LICENSE
1b TOTAL VOID
CLASS OF LICENSE NonResident Shtg. Pres. Fee $8.75
LIST IN SEQUENCE NUMBER OF FIRST AND LAST LICENSE SOLD
1a SERIAL NUMBER NUMBERS OF SOLD VOIDED LICENSE
1b TOTAL VOID
to to to to to to to to to to to to to to to to to to to to to TOTAL SOLD x REMIT X $23.25 = $
to to to TOTAL SOLD x REMIT X $8.75 = $
TOTAL VOID x REMIT X $8.75 = $
NonResident Annual Hunt Fee $60.75 Remit $60.00 Game Bird Habitat Stamp Fee $6.75 Remit $6.00
to to to to TOTAL SOLD x REMIT X $60.00 = $ to to TOTAL LICENSE to to to to TOTAL SOLD x REMIT X $6.00 = $ to to to to to to TOTAL SOLD x REMIT X $6.00 = $
TOTAL VOID x REMIT X $60.00 = $
TOTAL VOID x REMIT X $6.00 = $
TOTAL VOID x REMIT X $23.25 = $
Migratory Waterfowl Stamp Fee $6.75 Remit $6.00
Resident Benefactor Hunting Fee $50.00
to to to TOTAL SOLD x REMIT X $50.00 = $
TOTAL VOID x REMIT X $50.00 = $
TOTAL VOID x REMIT X $6.00 = $
Resident Benefactor Fishing Fee $50.00
to to to TOTAL SOLD x REMIT X $50.00 = $
TOTAL VOID x REMIT X $50.00 = $
NonResident Trapping Fee $117.75
to to to TOTAL SOLD x REMIT X $117.75 = $
TOTAL VOID x REMIT X $117.75 = $
Resident Benefactor Hunt & Fish Fee $50.00
to to to TOTAL SOLD x REMIT X $50.00 = $
TOTAL VOID x REMIT X $50.00 = $
Resident Turkey Fee $23.00 Remit $22.25
NonResident Turkey Fee $114.75 Remit $114.00 NonResident Deer Fee $120.75 Remit $120.00
to to to to TOTAL SOLD x REMIT X $114.00 = $ to to to to to to to to to TOTAL SOLD x REMIT X $120.00 = $
TOTAL VOID x REMIT X $114.00 = $
to to to to to to to to to to to to TOTAL LICENSE to to to to to to to to TOTAL SOLD x REMIT TOTAL VOID x REMIT X $22.25 = $
TOTAL VOID x REMIT X $120.00 = $
Annual Youth Hunting Fee $7.00 Remit $6.25
X $22.25 = $ to to to to to to to to to to to TOTAL SOLD x REMIT X $6.25 = $
NonResident 5-Day Hunt Fee $25.75 Remit $25.00
to to to to to TOTAL SOLD x REMIT X $25.00 = $ to to to to to to TOTAL SOLD x REMIT X $2.00 = $
TOTAL VOID x REMIT X $25.00 = $
Resident Disabled Veterans Hunt & Fish Fee $2.75 Remit $2.00
TOTAL VOID x REMIT X $6.25 = $
TOTAL VOID x REMIT X $2.00 = $